Get coverage for prescription drugs

Get help paying for prescription drugs when you qualify for the Ontario Drug Benefit program.

Ontario Drug Benefit program eligibility

You will qualify for the Ontario Drug Benefit (ODB) program when you turn 65 years old. Some of you will qualify before you reach that age because you’re:

living in a long-term care home or a home for special care, or

enrolled in one of these programs:

Home care

Ontario Works

Ontario Disability Support Program

Trillium Drug Program

OHIP+: Children and Youth Pharmacare

For seniors, the ministry will send you a letter three months before your 65th birthday.

What’s covered

The Ontario Drug Benefit program covers most of the cost of more than 4,400 prescription drug products.

It also helps you pay for:

allergy shots and EpiPen® (used in response to severe allergic reaction)

some products used in monitoring and testing for diabetes

some prescribed over-the-counter drugs under specific circumstances (e.g. Ibuprofen 200mg, Ferrous sulphate 300)

some nutrition products

some drugs used in treatment of HIV/AIDS

some drugs used in palliative care

help to quit smoking:

up to a year of pharmacist-assisted counselling (talk to your pharmacist or health care provider)

drugs (Champix or Zyban) if you are age 18 years or older

What’s not covered

The Ontario Drug Benefit is for residents of the province only. Make sure your health card is valid (e.g. hasn’t expired). Your pharmacist will need it to confirm your eligibility for the Ontario Drug Benefit program and submit a claim to the ministry.

To be covered by the ODB program, the prescription must be filled in a pharmacy in the province.

The following will not be covered by the Ontario Drug Benefit program:

prescription drugs that you buy outside Ontario

drugs that are not listed on the Ontario Drug Benefit formulary, or are not approved for the Exceptional Access Program

Adverse reactions to generic drugs

If you’ve had bad reactions to at least two generics, the ODB program covers the brand-name drug. In this case, your doctor:

fills out the Side Effect Reporting Form (which you can print and take on your next visit to your doctor)

writes no substitution on your prescription

Once filled out by your doctor, take the form and prescription to your pharmacist. Your pharmacist submits the completed form to Health Canada, which monitors drug safety.

Limited Use drugs

Some of the 4,400 prescription drugs listed on the Formulary are called Limited Use. These include drugs are covered only under special medical circumstances.

When you’re prescribed one of these drugs, your doctor or nurse practitioner must confirm that your circumstances require treatment with a Limited Use drug by writing a three-digit code on your prescription, called the Reason for Use code. It’s part of the drug’s information on the Formulary.

If you’re given a refill by your doctor or nurse practitioner, ask to make sure it’s still available for Limited Use treatment.  Some Limited Use drugs are covered for days or weeks, some for a year or years, while some are approved for lifetime coverage.  You should also ask your pharmacist to be sure.

Allergy shots and EpiPen®

You can get 100% of the cost of allergy shots and epinephrine auto-injector (e.g. EpiPen® or EpiPen Jr®), which are used in response to severe allergic reactions, covered by the Ontario Drug Benefit ODB program.

When you go to the pharmacy to get:

allergy shot medication, you need a prescription AND a Special Authorization Allergen form from your doctor or nurse practitioner

epinephrine auto-injector(s), you ONLY need a prescription from your doctor or nurse practitioner

For epinephrine products (e.g. EpiPen® or EpiPen Jr®) a Special Authorization Allergen form is NOT required. You are still required to have a valid prescription when you go to the pharmacy.

Antihistamines and mixtures used in testing for allergies are not covered by the ODB program.

What you pay

With the Ontario Drug Benefit program, you pay a portion of prescription-drug costs based on your yearly income (after taxes) and marital status. You can get coverage as a single senior (including widowed spouses) or as a couple (includes spouses who are married, same-sex or common-law partners).

Choose from one of these income groups to find out what you pay:

Single senior with income above $19,300

Senior couple with income above $32,300

Single senior with income of $19,300 or less

Senior couple with combined income of $32,300 or less

You may pay a different rate if you are:

living in a long-term care home or home for special care

enrolled in Ontario Works, Ontario Disability Support Program or Home Care

Single senior with income above $19,300

A single person aged 65 or older with a yearly income above $19,300 after taxes pays:

the first $100 of total prescription costs each year

called the deductible – paid down each time a prescription is filled

after paying the deductible, up to $6.11 for each drug prescribed, filled or refilled

this amount is called the co-payment

How it works

We will send you a letter reminding you that your ODB coverage is about to begin. The letter is sent three months before coverage starts.

This is a good time to tell your doctor, nurse practitioner and pharmacist. They can plan ahead to make sure you’re prescribed one of the more than 4,400 drugs approved for coverage.

Then, go to your pharmacy on the first day of the month after you turn 65 (e.g. if you turn 65 on April 15, go on May 1). This is your official start date in ODB.

Don’t forget your Ontario health card to show the pharmacist.

Senior couple with combined income above $32,300

A couple (one or both spouses aged 65 or older), with a combined yearly income above $32,300 after taxes, pays:

the first $100 per person of total prescription costs each year

called the deductible – paid down each time a prescription is filled

after paying the deductible, up to $6.11 for each drug that is filled or refilled

called the co-payment

How it works

We will send you and/or your spouse a letter confirming you qualify for ODB. The letter is sent three months before your coverage begins.

This is a good time to tell you and/or your spouse’s doctor, nurse practitioner and pharmacist. They can plan ahead to make sure to prescribe one of the more than 4,400 drugs approved for coverage.

Then, go to the pharmacy on the first day of the month after you or your spouse turn 65 (e.g. if you turn 65 on April 15, go on May 1). This is your official start date for ODB.

Don’t forget your Ontario health card to show the pharmacist.

Calculating first-year deductible

For your first year of ODB eligibility, depending on the month you turn 65, the deductible may be lower than $100.

That’s because the amount of the deductible is based on the number of months between your official start date (the first day of the month after you turn 65) and July 31 – the last day of the Ontario Drug Benefit program cycle.

For example, if you turned 65 on April 15, your official start date would be May 1. Counting from May 1 to July 31 your deductible for the first year would be $25.

Use this chart below to see what the deductible will be in your first year:

Single senior with income of $19,300 or less

If you’re a single senior, with a yearly income of $19,300 or less after taxes, you pay up to $2 for each drug filled or refilled—and you  do not have to pay a deductible.

Before this can take effect, you must fill out a Co-payment Application for Seniors.

Senior couple with combined income of $32,300 or less

A senior couple (one or both people aged 65 or older), with a combined yearly income of $32,300 or less after taxes, pays up to $2 for each drug filled or refilled—and does not have to pay a deductible.

Before this can take effect, a Co-payment Application for Seniors must be filled out.

Living in a long-term care home or home for special care

If you live in one of these types of homes, you are automatically covered by ODB. You pay up to $2 for each drug filled or refilled – and you do not have to pay a deductible.

Ask your your care coordinator or pharmacist how it works.

Enrolled in Ontario Works, Ontario Disability Support Program or Home Care

If you’re enrolled in one of these programs, you are automatically covered by ODB. You pay up to $2 for each drug filled or refilled – and you do not have to pay a deductible.

Ask your Ontario Works or Ontario Disability Support Program case worker how it works. Your pharmacist can also tell you.

Fill out Co-payment Application for Seniors

If you’re a single senior with annual income of $19,300 or less after taxes, or a senior couple (one or both spouses 65 or older) with annual income of $32,300 or less (after taxes), you must fill out and submit this form – before you can start paying the $2 co-payment.

The Ministry of Health and Long-Term Care will send you a letter confirming you qualify for ODB three months before your coverage begins. The letter can be your reminder to fill out the form.

Get a copy of the application:

by phone

1-888-405-0405 (toll free)

416-503-4586 (Toronto area)

in person at your pharmacy

Mail the completed application

Completed applications, including all required signatures and supporting documents, must be sent by mail to:

Ontario Drug Benefit Program

Ministry of Health and Long-Term Care

PO Box 384, Station D

Etobicoke, Ontario   M9A 4X3

How to get a 3-month supply

If you receive the ODB, or are in the Ontario Disability Support Program or the Trillium Drug Program, you can request a three-month supply of some drugs used to treat certain chronic conditions, such as:

diabetes

high cholesterol

high blood pressure

Getting a three-month supply of your prescription means you will pay co-payment fees less often.

Talk to your pharmacist to find out which drugs qualify and to learn how to request a three-month supply.

Coverage during travel

If you’re planning to travel in Ontario or outside the province, you may be able to get a larger supply.

Keep in mind that prescriptions filled outside Ontario are not covered by the ODB program.

For travel in Ontario

Your pharmacist can transfer your prescription to another pharmacy in Ontario, as long as:

your prescription has enough refills on it

you’re not refilling it too soon (within 10 days of end of supply)

your prescription is not for a controlled drug, controlled drug preparation or a narcotic (e.g., Percocet, Dilaudid, Xanax, Valium)

For travel outside Ontario

You can get a bigger supply, if your doctor or nurse practitioner has prescribed enough, but you can only do this once between August 1 and July 31 the following year – the ODB program year.

Here’s how it works:

if you have a supply of less than 30 days, you can get a travel supply of up to 200 days

if you have a supply of more than or equal to 30 days, you can only get a 100-day supply

if you’re enrolled in Ontario Works, you can only get a 35-day supply

Get a travel supply of medication

To get your travel supply, give your pharmacist one of the following:

letter (that you can write yourself) confirming you’re leaving the province for up to 200 days

copy of your travel insurance policy showing you’re leaving the province for up to 200 days

You have to pay the co-payment amount for the extra supply.