Drug Coverage in Ontario With the recent announcement from the conservative government that they will be changing the coverage for children and young adults under the age of 25 we thought it was a good time to do a blog on drug costs in Ontario. First of all lets review the different drug plans which are available through the Ministry of Health in Ontario. Below are the main public drug programs available to residents in Ontario. We are going to focus on the 3 programs highlighted, OHIP+, Trillium and the ODB Seniors Plan. The drug plans are very similar in that the for the most part they cover all the same drugs. There are some medications on the list that have restrictions on their use, and can only be used in patients over 75 years of age, or under 5 years of age etc. This generally is done for expensive medications to limit their use to those who would most benefit from the drug (although this can always be debated!). So if the drug coverage is generally the same what is different between the plans? The main difference in coverage is what you will pay for medications.
Trillium Drug ProgramCoverage is determined based on your income. The government collects all of your income information (and anyone else living in the same household) and will determine your deductible. You can see the deductibles based on net income here. The deductible you are given is split up over the year so that you don’t have to pay it all at once. Below is the example of a 800 dollar deductible. The deductible is the portion that you will have to pay, lets look at 2 examples to show how this works.
- Your drug costs are LESS than your deductible:
- Based on the example above if your medications cost less than 200 dollars between august and October you will pay the cost of your medications and receive no reduction in price.
- Your drug costs are HIGHER than your deductible:
- In this case you will still pay the 200 dollar deductible for the first 200 dollars worth of medication, but for any prescription costs over 200 dollars you will only pay $2.00 for each prescription.