Coverage & costs
Who pays for your prescriptions
Most people in Ontario are covered by something. The difficulty is almost never eligibility — it is knowing which program applies and getting the form in.
The programs
OHIP+ — anyone 24 or under without private drug coverage. Automatic; nothing to apply for.
Ontario Drug Benefit (ODB) — people 65 and over, people on Ontario Works or ODSP, people in long-term care or receiving home care. Largely automatic.
Trillium Drug Program — the one for everybody in between whose drug costs are high relative to household income. You apply; you get an income-based deductible; after that, covered prescriptions cost little or nothing.
Seniors Co-Payment Program — reduces what people 65+ on lower incomes pay per prescription under ODB.
Exceptional Access Program — the route for drugs that are not on the public formulary, where there is a clinical case. Needs a prescriber to apply.
Private and workplace plans — often stack with the above, and often cover things the public programs do not.
If you are paying full price for something, the most likely explanation is not that you are ineligible. It is that nobody has ever sat down and done the paperwork with you.
What we intend to do
- Work out which program applies to you, rather than asking whether you have coverage
- Fill in Trillium applications with you, not hand you the form
- Apply for Exceptional Access where a prescriber’s case supports it
- Tell you when a claim has been rejected, and why, before you are at the counter
- Chase fixable rejections — mismatches, missing authorisations — as our job
- Explain what an income-based deductible actually means for your household
- Say plainly when something is not covered anywhere, so you can plan
Why there are no prices on this site
The rule, since it looks like an omission
Ontario’s rules on advertising prescription drug prices require that an advertisement carrying a price for one prescription drug also carries prices for at least fifteen drugs across ten different classifications, each with strength, brand and dosage form, and all given equal prominence.
The intent is to stop pharmacies advertising a loss leader while everything else is expensive. The effect is that a useful, honest price list for one or two medications is not something a pharmacy can publish. So we do not, and instead we answer the question when you ask.
Common questions
I have no health card.
Tell us. It rules some programs out and not others, and there is often help available with getting a card if you are eligible for one. It is a common situation here and not a conversation-ender.
Is the Trillium deductible per drug?
No — it is per household, per program year, across all your covered prescriptions. That is why it is usually a better deal than people expect when they are only thinking about one medication.
Can you tell me what something will cost before I commit?
Yes. Asking what something will cost before you decide is completely reasonable, and it is a question we would rather answer in advance than have you discover at the till.
What if a public program covers it for free somewhere else?
Then we will tell you so, even though it means you filling it elsewhere. Toronto Public Health, for example, supplies medication for several sexually transmitted infections at no cost. Sending you there is the correct advice.