Gender-affirming care
Paying for hormone therapy
For most people in Ontario there is a program that covers this. Working out which one, and getting into it, is the part that stops people.
The programs, in plain terms
OHIP+ covers people 24 and under who do not have private drug coverage. If that is you, this is usually the whole answer and there is nothing to apply for.
The Ontario Drug Benefit covers people 65 and over, and people receiving Ontario Works or ODSP. Again, largely automatic if you are in one of those groups.
The Trillium Drug Program is the one most people in the middle need, and the one most people have never heard of. It is for households whose prescription costs are high relative to their income. You apply, you are assigned a deductible based on household income, and once you have paid that across the year, covered prescriptions are essentially free.
Private and workplace plans often cover hormone therapy too, sometimes alongside one of the above.
The most common reason people are paying full price is not that nothing covers them. It is that nobody sat down and filled in the Trillium form with them.
About that deductible
The Trillium deductible is roughly a percentage of household income, split across four quarterly instalments. People hear “deductible” and assume it is out of reach; for a lot of people on modest incomes it turns out to be considerably lower than they expected, and it applies to all your prescriptions rather than just one.
That last part matters. If you are also on PrEP, or an antidepressant, or anything for a chronic condition, those costs count toward the same deductible — so the maths is usually better than it looks when you only think about one medication.
Worth knowing
The program year runs August to July, and the deductible is based on the previous year’s income. If your income has dropped since then, that is something that can be raised rather than something you have to accept.
What we intend to do about it
Sit down with you, work out which program you fall into, and fill in the application with you rather than handing you a form and a website address. Keep track of where a claim is. Tell you when something has been rejected and why, instead of leaving you to discover it at the counter.
Where a claim is rejected for a fixable reason — a mismatch, a missing form, a product that needs a specific authorisation — chasing that is our job, not homework.
The same programs cover everything else you take, not just hormone therapy. The general version of this page goes through all of it.
Coverage and costs →Common questions
Why isn’t there a price on this page?
Because Ontario’s rules on advertising prescription drug prices are strict enough that publishing one properly would mean publishing a page of prices for a dozen unrelated drugs alongside it. That helps nobody. Ask us and we will tell you what your situation costs.
I don’t have status or a health card.
Say so early. It changes which programs are available and it does not mean there is nothing. This is a common situation in this neighbourhood and it is worth a proper conversation rather than an assumption.
I’m on a family member’s insurance and I don’t want them to know.
That is a real and common problem, because claims generate paperwork a plan holder may see. Tell us and we will go through the alternatives — there is sometimes a route that does not involve that plan at all.
Does Trillium cover injection supplies too?
Coverage for supplies is different from coverage for the medication itself and varies. We will tell you what applies rather than guessing on a web page.