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How to get free prescription drug coverage in Ontario, Canada

By Edited Oct 2, 2016 1 0

Ontario residents pay millions of dollars for their prescription drug purchase every year. The only way to avoid this extra expenditure is to have coverage for the purchase of such drugs. Prescription drug coverage can either be obtained through benefit package from the employer or by having a private insurance plan. Private insurance plans involve payment of premiums which can be considerably high. This abstains people with low household income from enrolling in such plans. For them the cost of prescription drugs can add up resulting in major portion of their earnings going towards prescription drug purchases.

Drug categories

There are two prominent categories of drugs that are available in Ontario. First category drugs are the ones that can be obtained without prescription from a health care professional and are known as Over-the-Counter (OTC) drugs. In Ontario, majority of insurance companies do not provide coverage for these drugs and the cost has to be bared by the consumer. The second category is the prescription drugs which can only be obtained with a valid prescription from a health care professional.

Things You Will Need

Ontario Drug Benefit: Trillium Drug Program

Trillium Drug Plan (TDP) is an Ontario Ministry of Health and Long-term care drug benefit program providing prescription drug coverage for Ontario residents with valid Ontario Health Insurance plan (OHIP). There is no fee or premiums to pay for this plan, however there is a deductible which is calculated based on the household income. The deductible is an amount that has to be spent on prescription drug purchase before TDP benefits are provided. The deductible amount is for one program year which runs from August 1st of one year to July 31st of the following year.

The fine print

There is very little fine print for this plan. Some of its salient features are:

· Any Ontario resident with a valid Ontario Health card can apply for this plan.

· There is no income threshold; no minimum or maximum income required to qualify for this plan. Every Ontario resident with valid Ontario Health card can apply.

· There is a deductible amount which depends upon the household income.

· The premiums paid towards private insurance plans or through payroll deductions, contribute to the deductible amount.

· The program runs from August 1st of one year to July 31st of the following year.

· Not all prescription drugs are covered under this plan. Only the drugs listed on the Ontario Drug Benefit Formulary/Comparative Drug Index (Formulary) are covered.

· The drugs not listed on the Formulary are also considered for coverage through the Exceptional Access Program (EAP).

Forms and more information

The application forms and additional information is available at most Ontario pharmacies or by calling the Ministry of Health at 1-800-575-5386. Application forms can also be downloaded from Ministry of Health and Long-term care website.

Two most common used forms are:

  1. Application for Ontario drug benefits. Form Number: 014-3693-87
  2. Special request forms and forms for drugs not listed on the Formulary.

Tips & Warnings



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