Ontario Public Drug Programs

Questions and Answers

You will find some short answers here to many of the questions people ask about Ontario drug plans. We have also included links where you can read more.


Getting prescription drugs

How do I get a prescription filled through the Ontario Drug Benefit (ODB) Program?
To have a prescription covered through the ODB Program, it must come from a health care provider licensed to practice and prescribe drugs in Ontario, and the product must be a benefit of the ODB Program. You will take your prescription to a drug store in Ontario to get it filled. Make sure you tell the drug store staff that you qualify for the ODB Program. The ODB Program will pay most of the cost of more than 3,800 prescription products (known as ODB benefits) if you qualify for the program.  You will be responsible for paying a small portion.
Do I have to get my prescription(s) filled in Ontario?
Yes. The ODB Program does not pay for prescriptions you get filled outside the province.
What if I forgot to tell the drug store staff that I am an Ontario Drug Benefit recipient?
If you did not tell the drug store staff that you were an Ontario Drug Benefit recipient, you may have paid for your drug. You can send your prescription receipt(s) to the ministry for reimbursement, if the drug is an ODB benefit. You can call the drug store to check if the drug is an ODB benefit.

On your next visit to the drug store you should inform the drug store staff that you are eligible for the Ontario Drug Benefit Program.

How do I get my prescription receipts reimbursed if I am an Ontario Drug Benefit (ODB) Program client?

You can send your official pharmacy prescription receipts to one of the following two addresses for reimbursement:
ODB clients (except for Trillium Drug Program clients):
Drug Benefit Programs
P.O. Box 384, Station D
Etobicoke ON M9A 4X3

Trillium Drug Program clients:
Drug Benefit Programs – Trillium Drug Program
P.O. Box 337, Station D
Etobicoke ON M9A 4X3

What is required if I want to get my prescription receipt reimbursed by the ODB Program?
To get a prescription reimbursed by the ODB Program, the drug must be filled in Ontario by a drug store or doctor that is on-line with the ministry’s Health Network System.  And, your prescription receipt must include:
  • Your name
  • Date your prescription was filled
  • Prescription (Rx) number
  • Drug or Product Identification Number (DIN/PIN)
  • Drug or product name
  • Drug or product cost
  • Quantity
  • Dispensing fee
  • Total amount you paid
  • Name of the doctor who wrote the prescription
  • Name and address of the drug store
What if I lose the receipt my drug store gave to me for my prescription?
Ask your drug store to give you a new copy. If you have a lot of prescription receipts to claim, you can ask your drug store to prepare a “Patient Profile.” This has the same information as your prescription receipt, plus:
  • the drug store’s stamp
  • the signature of the person who filled your prescription (your pharmacist)
If my doctor fills my prescription in his/her office, will the ODB Program pay for the cost of my prescription?
Only a small number of doctors are allowed to fill a prescription in their office and have the costs paid for by the ODB Program. If your doctor is not linked to the ministry’s Health Network System, then the prescription will not be reimbursed.
What quantity of medication can be dispensed by my pharmacist at one time, and what can I do if I am going away for a longer period of time than the amount of medication my pharmacist dispenses to me?

The quantity of medication dispensed by a pharmacist is directed by the prescription from the patient's physician. The ministry does not regulate the quantity of prescription drugs dispensed except in limited circumstances, e.g. section 9(1) of the Drug Interchangeability and Dispensing Fee Act (DIDFA) directs that "Every person who dispenses a drug pursuant to a prescription shall dispense the entire quantity of the drug prescribed at one time unless before the drug is dispensed the person presenting the prescription in writing authorizes the dispensing of the drug in smaller quantities".

As well, through the ministry's public drug programs, the regulations under the Ontario Drug Benefit (ODB) Act stipulate that the ministry can only pay for a maximum 100-days supply of drug products at one time when prescribed by an Ontario physician and dispensed by an Ontario pharmacist. However, the first prescription of a newly prescribed drug is limited to a 30-day supply; subsequent prescriptions may then be prescribed for up to 100 days. ODB puts no other restrictions on the amount of a drug prescribed at one time (* see exceptions, below).

The ministry limits the supply of prescription drugs dispensed at one time to 100 days to reduce drug product waste. As illustrated by consumer groups, seniors and pilot projects, a lot of prescription medications are wasted through large-quantity prescribing. The ministry does not restrict the amount of a prescription drug dispensed at one time for Ontarians who are not recipients of the ministry's drug programs or for drugs not listed on the Ontario Drug Benefit Formulary, the list of benefits for eligible drug program recipients.

Vacation supplies may be allowed depending on which category the client is eligible to receive ODB program benefits under.

A second 100-day prescription drug supply may be dispensed at one time to specific categories of ODB program recipients (exceptions are noted below) who are travelling outside Ontario between 100 and 200 days, and who can provide the required documentation to their pharmacist. This documentation includes:

  • a letter written by the recipient confirming that he or she is leaving the province for more than 100 days, or
  • a copy of their travel insurance confirming that he or she is leaving the province for between 100 and 200 days.

For people travelling outside of Ontario who will be away for an extended period of time and require more than the extra 100-day vacation supply of prescription drugs, the ministry allows an additional early refill of a 100-day drug supply to be dispensed if the recipient has less than a 30-day supply on the balance of their current prescription.

If the recipient has more than a 30-day supply of their current prescription, only the vacation supply may be dispensed.  The normal co-payments and deductibles apply to each 100-day supply.

For example, if an ODB recipient has 20 days left of a current prescription and requires a vacation supply because they are leaving Ontario for 150 days, the pharmacist can submit a claim for a refill up to a 100-day supply and an additional 100-day supply at the same time. If an ODB recipient has 40 days left, the pharmacist can submit a claim for 100-day vacation supply only.

* Exceptions:

  1. Clients of the Trillium Drug Program (TDP):

During the 3rd quarter, if a Trillium Drug Program (TDP) household has not met its annual deductible, the days' supply cannot extend beyond May 30th (i.e. cannot extend more than 30 days beyond the end of the 3rd quarter).

The 100 days' supply limit applied to TDP recipients will be reduced for each day after February 20th (i.e. the days' supply limit for a February 21st dispense date will be 99 reducing by 1 with each passing day). The last two months of the benefit year are left open to collect outstanding deductible contributions prior to the end of the benefit year.

In the 4th quarter, even if the household has met the annual TDP deductible, the days' supply limit cannot extend beyond August 31st (i.e. cannot extend more that 30 days beyond the end of the 4th quarter). In other words, household members who are eligible for TDP benefits can receive a maximum of 100 day's supply provided the supply does not extend more than 30 days into a new TDP benefit year.

  1. Clients of Ontario Works (OW):

Ontarians eligible for ODB program benefits through the Ministry of Community and Social Services' Ontario Works program are only eligible to receive a maximum 35 days' supply at one time. The patient may wish to discuss OW's maximum days supply restrictions with their OW caseworker.

  1. Clients who have private insurance coverage in addition to being eligible for ODB program benefits:

If the patient has private insurance coverage for their prescription drugs in addition to ODB program coverage, they are advised to confirm their maximum days supply restrictions with their private insurance company.

If an ODB recipient needs to purchase a vacation supply of medication but they do not have the appropriate documentation and/or the vacation supply cannot be processed at their pharmacy through the Health Network System (HNS), the ODB recipient can send the receipt to one of the following two addresses for consideration of reimbursement:

Trillium Drug Program
PO Box 337, Station
Etobicoke ON  M9A 4X3

Ontario Drug Benefit Program
(except for the Trillium Drug Program)
PO Box 384, Station D
Etobicoke ON  M9A 4X3

The reimbursement of vacation supplies not processed through the HNS at the pharmacy is not guaranteed.

It is advisable that Ontario residents traveling outside the province or country consider purchasing medical insurance to cover the cost of emergency prescriptions that may be needed.

What are dispensing fees?
Your drug store charges a dispensing fee for filling your prescriptions and providing other services. For example, they:
  • maintain your medication records
  • provide information on the drug you are taking
  • check the list of other drugs you are taking to make sure there are no concerns of taking the drugs together
  • talk to your doctors
  • stock the medicines you need and more

The dispensing fee most drug stores charge is $8.20. Stores in rural areas may charge more.

What are brand name drugs?
Brand name drugsare the first of their kind approved for use in Canada. Companies that develop these drugs hold a patent on the formula. A patent gives the drug manufacturer the sole right to produce the drug.

Read more >>

What are generic drugs?
The patent for a brand name drug does not last forever. When the patent ends, other drug manufacturers can make a drug that is like the brand name drug in every important way. These are called generic drugs. Generic drugs have a different name and may look or taste different from brand name drugs. They also cost less. But they have the same key ingredient(s).

Read more >>

Back to top

About the Ontario Drug Benefit (ODB) Program

What is the Ontario Drug Benefit (ODB) Program?

The Ontario Drug Benefit Program covers most of the cost of:

  • more than 3,800 prescribed drugs
  • some nutrition products
  • some diabetic testing agents.

You can join the program if you:

  1. live in Ontario, and
  2. have a valid Ontario Health Card, and
  3. one of these statements applies to you:
    • I am age 65+
    • I live in a Long Term Care Home or a Home for Special Care.
    • I am enrolled in the Home Care program and receiving a professional service.
    • I have high drug costs relative to my income.
    • I receive social assistance through Ontario Works or the Ontario Disability Support Program.

Apply now

Who can join the ODB Program?

To join, you must:

AND one of these statements applies to you:

  • I am age 65 or older.
  • I live in a Long-Term Care Home or a Home for Special Care.
  • I am enrolled in the Home Care program.

OR if you are younger than age 65, you may be able to join the ODB Program if you are enrolled in:

  • the Trillium Drug Program
  • Ontario Works
  • the Ontario Disability Support Program

Read more >>

Do I have to pay a fee for my prescriptions? When are those fees due?
The benefit year for the ODB Program is from August 1st to July 31 of the next year.

There are two types of fees that you may be asked to pay; one is called a “deductible” and the other is called a “co-payment”. 

Only some seniors and Trillium Drug Program clients have to pay a deductible.  You pay your deductible by purchasing ODB benefits at your drug store. 

After your deductible is paid, or if you don’t have to pay a deductible, you may be asked to pay a small amount towards the dispensing fee; this amount is called a co-payment.

Read more >>

Back to top

What the ODB Program covers

What prescription drugs does ODB help pay for?
The ODB Program covers the cost of more than 3,800 prescription products. This includes prescription drugs and some nutrition products and diabetic testing strips. Read more or view a list of approved drugs
Will the ODB Program help pay for allergy shots?
Yes. The ODB Program covers the costs of shots given to you by your doctor to treat severe allergy symptoms. The program does NOT cover antihistamines or tests to see if you have allergies.

Read more >>

Will the ODB Program help pay for diabetic testing strips?
Yes. ODB will help pay for a number of these products. Please ask your pharmacist if your diabetic testing strip is covered.

Read more >>

Will ODB help pay for nutrition products?
Yes. ODB will help pay for some of these products under specific circumstances. For instance, an Ontario doctor must prescribe the product as the patient’s sole source of nutrition. Please ask your pharmacist if your nutrition product is covered.

Read more >>

What are Limited Use (LU) drugs?
Some drugs are covered under the ODB Program on a limited basis only. They are often drugs that you take for a long time, with many repeat prescriptions. Or, they may be drugs that have strict rules to follow when you take them before the ODB Program will pay for them. For example, the ODB Program will only pay for some drugs for a short amount of time, and some drugs will only be paid for if you have a specific disease or medical problem. These are called Limited Use (LU) drugs. Your doctor must follow a special process to get approval for these products.

Read more >>

I need a drug that is not on an ODB benefit. What do I do?
Ask your doctor if there is an appropriate alternative covered by the ODB. If not, ask your doctor if he/she can request to coverage through the Exceptional Access Program (EAP) on your behalf. Please note, not every request is approved. View a list of the most common drugs people ask for through the EAP.
What if my doctor sends me to another province to see a specialist and my specialist wants to apply to the EAP?
Requests for drugs through the EAP must come from a health care provider licensed to practice and prescribe drugs in Ontario. If your specialist is from another province, he/she will have to work with a doctor who is licensed in Ontario, and the Ontario doctor would need to submit the EAP request.
What are “over-the-counter” drug products and does the ODB Program pay for them?

Some drugs are available without a prescription. These are called over-the-counter (OTC) drug products. The ODB Program may cover some of these products when:

  • There are no alternatives and you need them to avoid a medical crisis
  • Other options are toxic or more costly
  • The OTC drug must be used with an already prescribed ODB approved product
  • The OTC drug is being used to treat an easily spread serious disease (Example: TB)

Read more >>

Does the ODB Program pay for things like syringes and other diabetic supplies such as lancets and glucometers, medical devices, eyeglasses, dentures, hearing aids, or compression stockings?
No, the ODB Program does not pay for those types of items.  You can check with the Assistive Devices Program if these items are covered for you.

Back to top

When you travel

Will the Ontario Drug Benefit Program pay for prescriptions I get filled outside Ontario?
No. You will have to pay the full cost of your prescription drugs if you have them filled by a drug store outside Ontario.

Tip: Get a travel supply from your drug store before you leave the province. Read more about travel supplies.

Under the Ontario Drug Benefit Program, how much medication can I get for my trip outside the province?
If you travel outside the province between 100 and 200 days, the ODB Program may pay for a travel supply of medication. Certain rules apply about how much you can get. For example, if you receive support from Ontario Works, the most you can get is a 35-day supply. Other people may get a 100 or 200-day supply. Read more about travel supplies.
Will the Ontario Drug Benefit Program pay for prescription drugs I buy outside of Ontario in an emergency?
No. To cover those costs, you should get private medical insurance before you leave the province.

Read more >>

Back to top

About the Trillium Drug Program

What is the Trillium Drug Program?
The Trillium Drug Program helps people who have high prescription drug costs relative to their household income. You will pay a set amount of your costs each year known as a deductible. This amount equals about 3% to 4% of your household’s total net income. Net income is the amount of money you have after you pay your taxes.
When can I apply to the Trillium Drug Program?
You can join at any time during the year. Make sure you include all the required documents when you apply.

The program year runs from August 1st to July 31st of the next year. If you would like to apply for the previous program year, your application must be received within two months of the end of the previous program year, in other words before September 30th of the current year.

Example: If you want to join the 2011-2012 program year (i.e. the program year that began on August 1, 2011 and ended on July 31, 2012), your application must be postmarked no later than September 30th, 2012.

When can I submit my receipts and insurance statements to the Trillium Drug Program?

The program year runs from August 1st to July 31st of the next year. You can submit your receipts and insurance statements at any time during the program year, but the Trillium Drug Program must receive all your prescription receipts and insurance statements within three months following the end of the program year in other words before October 31st of the next year.

Example: For the 2011-2012 program year, you must have applied to join the program before September 30, 2012 and submit your receipts and insurance statements before October 31st, 2012.

I forgot to choose an enrolment start date when I applied to the Trillium Drug Program. Can I change it later?

No. If you do not fill in the enrolment start date on your application, we will use August 1st as your start date. We will calculate the deductible for your household for the whole program year. The program year for Trillium runs from August 1st to July 31st of the next year.

I am enrolled in the Trillium Drug Program. The manufacturer of my medication is offering to pay for the drug I need. Can I apply the amount the manufacturer pays towards my Trillium Drug Program deductible?
No. You must still pay the deductible yourself. It’s a cost that everyone in the Trillium Drug Program must pay. The fact that the manufacturer pays all or even just part of your drug costs does not change your share of what you have to pay towards the deductible.
How is the TDP deductible calculated?
The TDP deductible is based on the household’s prior year’s total net income.  In other words, for the 2011/12 Trillium Benefit Year, the household’s deductible would be based on the household’s total 2010 net income.  The deductible is approximately 4% of the household’s net income.
How is the TDP deductible paid?
The deductible your household will have to pay is split into four equal amounts over the year and is paid starting on August 1st, November 1st, February 1st, and May 1st.  Your household pays for its deductible by purchasing ODB approved prescription drug products at its pharmacy. Once the household has purchased enough of these products to equal the amount of its deductible each quarter, then for the rest of that quarter, each household member will only have to pay up to $2 per approved prescription drug product (i.e. the co-payment).
What happens if my household’s net income drops more than 10%?
If a TDP household’s net income had decreased by 10% or more in 2011 over the 2010 taxation year, a household can request that its deductible be reassessed based on the household’s income from 2011.  The TDP can change the deductible at any point during the benefit year in order to assist households whose income has been reduced due to unforeseen circumstances.
How I can request an in-year reassessment of my household’s net income?
Provided your household’s net income has decreased by 10% or more in the current calendar year over the previous calendar year, you will need to write a letter to the Trillium Drug Program requesting that your household’s deductible be based on your household’s current year’s net income.  Along with this letter, you will need to include copies of supporting documentation of each household member’s actual income for the current taxation year.  The types of documentation each household member should include are: 
  • Notice of Assessment(s);
  • T1General(s);
  • T4(s);
  • Letter(s) of employment verifying their gross annual income;
  • Record of Employment (ROE) form(s);
  • Canada Pension Plan (CPP) entitlement document(s);
  • Old Age Security (OAS) document(s);
  • Employment Insurance (EI) document(s);
  • Disability payment document(s);
  • Other income sources as may apply.

When all documentation has been received and reviewed, the TDP will determine your household deductible and you will be notified accordingly.  

If my recalculated deductible is lower than what was assessed at the beginning of the year, will I get a reimbursement of any excess deductible amount I may have already paid?
An in-year reassessment of your deductible is only in place to assist households to meet their deductible and not for reimbursement purposes.  Per TDP policy, if an overpayment by the household occurs as a result of the recalculated deductible, no reimbursement will be provided by the TDP.  The new deductible will apply to the remaining quarters in the TDP benefit year but will not be applied retroactively.  The TDP cannot reassess any allowable drug expenses which were incurred by a household prior to the date on which the deductible was changed.

Back to top

Other Ontario Drug Programs

What is the New Drug Funding Program (NDFP)?
This program covers certain approved injectable cancer treatments you receive in a hospital. The NDFP pays 100% of these cancer drugs if you qualify. To learn more, talk to your doctor and they will fill out the necessary forms for you.

Read more >>

What is the Special Drugs Program(SDP)?
This program covers the full cost of certain outpatient drugs used to treat a number of serious conditions. To qualify, you must:
  • live in Ontario
  • have a valid Ontario health card
  • have a prescription for the drugs from an Ontario doctor, and
  • receive the treatment from a designated center

To learn more, talk to your doctor and they will fill out the necessary forms on your behalf.

Read more >>
What is the Inherited Metabolic Diseases(IMD) Program?

The program covers the full cost of certain outpatient drugs, supplements and specialty foods used to treat metabolic disorders. To qualify, the metabolic disorder and funded products must be on the List of Disorders, Covered Drugs, Supplements and Specialty Foods. To apply, talk to your doctor.

Read more >>
What is the Respiratory Syncytial Virus (RSV) Program for high-risk infants?
This program covers the full cost of the drug PALIVIZUMAB. It is used to prevent a serious lower tract respiratory infection in certain high risk infants. To qualify, your child(ren) must:
  • live in Ontario
  • have a valid health card
  • meet the treatment guidelines that the ministry sets at the start of each RSV season

Read more >>

What is the Visudyne (verteporfin) Program?

This program covers the full cost of the drug VERTEPORFIN. It slows the advance of age related eye condition (macular degeneration). To qualify, you must:

  • live in Ontario
  • have a valid health card
  • meet the criteria set out in the program rules
Read more >>

Back to top

Other questions

What is the Ontario Health Network System?

The Health Network system is a province-wide computer system. It links Ontario drug stores and some doctors directly to the Ministry of Health and Long-Term Care. We use the system to:

  • process requests and claims for prescription drugs
  • support the safe use of drugs
  • find ways to improve our drug programs
Read more >>
How are drugs approved for Ontario Drug Programs?

The ministry has put clear steps in place to review new drugs for Ontario’s Drug Programs. The drug manufacturer must ask for and receive approvals from:

Read more >>

Back to top

For More Information

Call ServiceOntario, Infoline at 1-866-532-3161
In Toronto, 416-314-5518
TTY 1-800-387-5559
In Toronto, TTY 416-327-4282
Hours of operation : 8:30am - 5:00pm