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Cathleen Wright

The Ontario Drug Benefit Program takes care of most of the cost of over 4,000 prescription drugs under specific circumstances. As long as you have an Ontario Health Card, live in the province, and match the program’s criteria, you’re eligible to get started. But this handy, straightforward guide will help you get the most out of it.

When You’re a Senior...

Let’s start with an easy one. A couple months before you turn 65, you’ll be notified by mail (assuming the ministry has your correct address) that you qualify for the Ontario Drug Benefit Program. The day after your birthday, you’ll get the best gift of all—instant drug benefits, with no formal applications necessary. All you’ll need to do is take your prescription to the pharmacy, tell the pharmacist you’re eligible for the program, and they’ll link to Ontario’s Health Network System to verify your age and qualifications.

There’s a $100 deductible, often paid upfront at the drug store, followed by a small fee you may be asked to pay (up to $6.11) every time you fill a prescription. Note that the first time you pay your deductible, it may be well below $100. Since the Ontario Drug Benefit Program year begins on August 1st, if you turn 65 in, say, April, you’ll only be paying for a few months of benefits (May to August 1st), meaning the cost will be about $25.00. The following year onward you’ll pay the full $100.

If your yearly net income is lower than $16,018, you’re a senior couple whose combined yearly net income is under $24,175, or you’re registered with one of a few specific programs, you can fill out a special co-payment form and pay only $2 each time you fill a subscription.

When Your Drugs Cost A Lot...

In cases where your drugs are expensive and your income just can’t meet the cost, the Ontario Drug Benefit Program offers a special application form. Known as the Trillium Drug Program Application for Ontario Drug Benefits, the form can be found on the Ontario government website (code 3693-87). It covers individuals and households in which people are financially dependent on each other (such as children or grandparents who live with you, a spouse who lives with you, or children who do not live with you but who are financially-dependent students). Applications require a couple signatures from all household members over the age of 16, as well as proof of income or consent to go to the Canada Revenue Agency, private insurance company letters where applicable, and legal authority for power of attorney where applicable. Missing any of this information is the most common reason for a rejected application, so read through the form diligently. It must be mailed within two months following the end of the Trillium Drug Program benefit year—since the year ends July 31st, the due date is September 30th.

When You Live in Long-Term Care

You’ll need to talk to your Community Care Access Centre representative. Healthcareathome.ca has an online tool to help you find the Access Center closest to you. You can also simply type CCAC into Google Maps, and find locations marked specifically as “Community Care Access Centres.” If you’re having any doubts about the validity of a location, call before you make a trip—their phone numbers will be listed when you click the location, and they’ll be able to offer further information.

Everything You Need to Know about Group Benefits & Insurance

Cathleen Wright

With over 30 years of experience, Cathleen possesses an ever-growing knowledge of all aspects of group employee benefits, combined with expertise in the evolving landscape of the insurance industry. She is HIAA and ADR certified, in addition to numerous other professional sales and service certifications. When not working, Cathleen can be found at home watching the Leafs or the Blue Jays, and if it’s summer, she’ll be unplugged at the cottage with a book. Year round yoga is a must to maintain serenity, and a glass of wine or a margarita doesn’t hurt!
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