The Ontario Drug Benefit (ODB) Program


What does the program cover?

The Ontario Drug Benefit (ODB) Program covers most of the cost of 3,800 prescription drug products, some nutrition products and some diabetic testing agents. The list of products covered by the ODB program is called the "Formulary". Some products listed on the Formulary will only be funded in limited circumstances and/or for a limited duration in time.

As well, under special circumstances the Exceptional Access Program may cover most of the cost of various drug products that are not on the Formulary for people in the ODB Program.  Your doctor must apply on your behalf.  Approval must be given by the ministry before a drug will be funded by the program if it is not on the Formulary.

To qualify, an Ontario doctor or other authorized prescriber must prescribe the drugs and you must buy them from either:

  • an accredited Ontario pharmacy OR
  • an Ontario doctor who is licensed to sell prescription drug products and is linked to the ministry’s Health Network System.
What is not covered?
  • Prescription drugs that you buy outside Ontario;
  • Prescription drugs that you buy at your doctor’s office if the doctor is not linked to the ministry’s Health Network System.
  • Syringes and other diabetic supplies such as lancets and glucometers, eyeglasses, dentures, hearing aids, or compression stockings.
Who is eligible?

You are eligible for ODB program benefits if you live in Ontario, you have a valid Ontario health card and at least one of these statements applies to you :

What costs will I pay?

If you are covered by the ODB program and your prescription drugs are listed on the Formulary, or have been given pre-approval through the Exceptional Access Program, the program will pay most of your costs. Learn more >>

How do I get ODB program benefits?

If you are a senior:

On the first day of the month after you turn 65 years of age, take your prescription and health card to your pharmacy. Tell the pharmacist that you are now eligible for the ODB program. Depending on your income, you might be able to pay a lower payment per prescription through the Seniors Co-Payment Program.

If your drugs costs are high relative to your income:
If you live in a Long-Term Care home or a Home for Special Care, or you are enrolled in the Home Care system:

Talk to your Community Care Access Centre representative.

If you receive social assistance:

Talk to your Ministry of Community and Social Services case worker.

More about the Ontario Drug Benefit Program

ODB and seniors: What happens once you turn 65?
If you have turned 65, live in Ontario and have a valid Ontario health card, you qualify for ODB benefits. You do not need to apply, but you will pay a small portion of the costs of your drugs.

ODB and travel: What happens if you travel out of the province?
Find out how and if you can obtain a vacation supply of medication before you leave Ontario.

Special drug requests

Exceptional Access Program (EAP)
In very special cases, EAP covers drugs that are not on the approved ODB list. This includes cases where drugs on the ODB list have been tried and do not work; or, where an alternative drug is not available through ODB.

Compassionate Review Policy (CRP)
In rare and life-threatening cases, ODB funding may be approved if the Executive Officer has not made a final funding decision.

Other items covered under ODB

Allergy Products
Does your doctor treat your allergies by injection? If so, ODB may cover your costs.

Diabetic Testing Agents
Are you diabetic and need to test your blood sugars? ODB covers some agents used in testing.

Nutrition Products
Has your doctor or health care provider subscribed nutrition products for you? If these products are your sole source of nutrition, ODB may cover your costs.

Over-the-Counter Drug Products
Drugs that you buy without a prescription are called over-the-counter drugs. ODB covers some of these products if prescribed by your doctor.

Other

Limited Use Drug Products
Some ODB drug products are covered in limited situations where specific medical conditions must be met.

Generic Drugs
Has your doctor prescribed generic drugs for you? ODB covers many generic drugs. These drugs have the same key ingredient(s) as the original brand name drug, but have a different name and may look or taste different.

Dispensing Fees
You will likely pay a fee when a pharmacy or dispensing physician fills your prescription(s). Find out more about what those fees cover and who pays.

Health Network System
Ontario has invested in building a province-wide computer network system. This system links Ontario pharmacies directly to the ministry. Find out how it helps prevent the unsafe or unauthorized use of prescription drugs. 

For More Information

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