Ontario Ministry of Health and Long-Term Care - Public Information - Ontario Drug Benefits - Questions and Answers

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Ontario Drug Benefits : Questions and Answers

What happens if I need prescription drugs?

You may receive eligible prescription drugs at a small cost to you if you are a recipient of the Ontario Drug Benefit (ODB) Program.

The Ontario Drug Benefit (ODB) program provides coverage to the following categories of Ontario residents with valid Ontario health cards :

Seniors (those over 65 years of age)
People on social assistance (Ontario Disability Support Program and/or Ontario Works)
People residing in homes for special care and long-term care homes
People receiving professional home care services.

In addition, any Ontario resident (with a valid health card), who does not fit into the categories outlined above can become eligible for ODB drug benefits by registering in the Trillium Drug Program (TDP). The TDP is intended to provide access to ODB drug benefits to those who have high drug costs in relation to their household net income, and who have little or no private insurance coverage.

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How much do I pay?

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

ODB Recipient	Deductible/Co-payment
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. Note : All newly eligible seniors are automatically enrolled in this “higher co-payment” category.	100 deductible per senior per year in ODB eligible prescription drug charges After the $100 deductible is paid, these seniors pay up to $6.11 co-payment toward the dispensing fee each time they fill an ODB eligible prescription.
Single seniors (people aged 65 or older) who have an annual income below $16,018 and seniors in couples whose combined annual income is less than $24,175. NOTE : All Newly eligible seniors are automatically enrolled in the “higher co-payment” category. If seniors think they may be eligible for this lower “$2 co-payment”, then they can complete an application form and send it to the ministry. This will ensure that they are placed in the right co-payment category.	These seniors may be asked to pay up to $2 co-payment toward the dispensing fee each time they fill an ODB eligible prescription.
Trillium Drug Program (TDP) recipients	After their Trillium deductible is paid, these recipients may be asked to pay up to $2 co-payment toward the dispensing fee each time they fill an ODB eligible prescription. Note : The deductible is paid in four installments over the program year and is calculated based on net household income and household size.
All other ODB recipients as follows : people on social assistance people residing in homes for special care and long-term care homes people receiving professional home care services	These recipients may be asked to pay up to $2 co-payment toward the dispensing fee each time they fill an ODB eligible prescription.

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What prescription drugs can I receive ?

Under the Ontario Drug Benefit (ODB) program ODB recipients are eligible for the over 3,200 drug products listed in the Ontario Drug Benefit Formulary.

As well, some drugs that are not listed in the Formulary are considered for coverage, on a case-by-case basis through the ministry's Exceptional Access Program, following a written Individual Clinical Review request by a patient’s physician.

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What is the Trillium Drug Program ?

This program helps you if you have high prescription drug costs in relation to your income.

To receive benefits through the Trillium Drug Program, you must first pay a certain amount (deductible) of your family's net household income towards eligible prescription drugs. Once you have met your deductible, you will pay up to $2 for each eligible prescription filled.

If you have questions, call the Trillium Program Hotline at 1-800-575-5386 or e-mail at trillium@resolve.com

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What if I am outside Ontario ?

You have to pay the full cost of prescription drug costs when a pharmacy outside Ontario fills your prescription, even if you are covered by the Ontario Drug Benefit program.

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Drug Programs Branch 5700 Yonge Street, 3rd Floor Toronto, Ontario M2M 4K5 Canada Tel : 416-327-8109 Fax : 416-327-8123 Toll-free : 1-866-811-9893 TTY : 1-800-387-5559 E-mail : DrugPrograms@moh.gov.on.ca Seniors call In Toronto, call 416-503-4586 Toll-free : 1-888-405-0405 or E-mail : seniors.copayment@resolve.ca	Trillium recipients contact P.O. Box 337, Station D Etobicoke, Ontario M9A 4X3 Tel : 416-642-3038 Fax : 416-642-3034 Toll-Free : 1-800-575-5386 E-mail : trillium@resolve.com 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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