Guides
Is PrEP free in Ontario?
For many people it costs nothing or close to it. For some it costs real money. It depends on your age, your drug plan and your income, so find your line below.
The short answer
With OHIP, the visits and the lab tests are covered. The medication is not: a drug plan pays for it, and which plan you have decides what is left for you.
OHIP pays in full for medically necessary visits to a doctor, including at a walk-in clinic. It also covers the lab tests a doctor or nurse practitioner orders, at a community lab or a hospital.
What OHIP does not cover is a prescription filled outside a hospital. For PrEP, that part is paid by OHIP+, the Ontario Drug Benefit, the Trillium Drug Program, a private plan, or you.
The Ontario HIV Treatment Network says most people in Ontario already have a drug plan that covers all or most of the cost. The rows below are for working out which one is yours.
Find your situation
Open the one that sounds like you. Each says who pays, and links to the rule it rests on.
You’re 24 or under, and not on a private drug plan
OHIP+ covers it. There is nothing to apply for. With OHIP coverage, the pharmacy fills the prescription at no charge — no deductible and no co-payment.
Source: OHIP+, on ontario.ca
You have a private or workplace drug plan
Your plan pays first. What is left for you depends on the plan, so it is worth asking what share you pay before the first fill. If you’re 24 or under, OHIP+ does not apply while you are on a private plan.
If the plan does not pay for all of your prescriptions and what is left is high for your household income, the Trillium Drug Program can cover the rest. A plan holder, such as a parent or a partner, may be able to see the claim — if that matters, raise it before the first fill.
You’re 65 or older
The Ontario Drug Benefit covers it. Depending on your income, you pay a yearly deductible and then a co-payment each time a prescription is filled — or, through the Seniors Co-Payment Program, no deductible and up to $2 a prescription.
You receive Ontario Works or ODSP
The Ontario Drug Benefit covers it. There is no deductible. You pay up to $2 each time a prescription is filled or refilled.
You’re 25 to 64, with no drug plan
PrEPStart first, then Trillium. This is the situation where PrEP can still cost real money, so it is worth a plan rather than a guess.
PrEPStart, run by the Ontario HIV Treatment Network, gives three months of PrEP free to people who do not have a drug plan. Your prescriber faxes a form to the program’s pharmacy, which ships to you if you live outside Toronto.
For after that, the Trillium Drug Program has a yearly deductible of about 4% of your household’s after-tax income, paid in four instalments. Once it is met, you pay up to $2 a prescription until the program year ends.
Sources: PrEPStart, on ontarioprep.ca · Trillium Drug Program, on ontario.ca
You don’t have an Ontario health card
PrEPStart may still apply. OHIP+ and the Trillium Drug Program both need Ontario health coverage. PrEPStart is open to people with an Ontario health number, and also to people enrolled in a federal health insurance program — for example First Nations and Inuit people, refugees and refugee claimants.
If you are eligible for OHIP and simply do not have a card yet, getting one comes first, and it is reasonable to ask for help with it.
Source: PrEPStart, on ontarioprep.ca
25 to 64, with no drug plan
This is the situation where PrEP is most likely to cost money, and where a plan beats a guess. Three steps, in this order.
Ask about PrEPStart
It gives three months of PrEP free to people with no drug plan. After your assessment and tests, your prescriber faxes a form to the program’s pharmacy. In Toronto you pick it up; elsewhere in Ontario it is shipped.
Apply to Trillium in those three months
PrEPStart’s support line, 416-903-9992, helps with the application. Trillium’s deductible is about 4% of your household’s after-tax income, split into four instalments.
Then pay up to $2 a fill
Once a quarter’s share of the Trillium deductible is paid, each fill costs up to $2 under the program until the quarter ends.
One detail matters on the Trillium form. The start date you choose decides which prescriptions count, and it cannot be changed later. The Trillium guide explains how to pick it.
Federal coverage
Some people are covered by a federal program instead. Ontario PrEP lists the Non-Insured Health Benefits program for eligible First Nations and Inuit people, the Interim Federal Health Program, Canadian Forces Health Care and Veterans Affairs Canada as covering PrEP for the people they serve.
If you have a private plan
Your plan pays first, and what is left depends on the plan. Ask what share you pay before the first fill. A pharmacist can check, with your insurance card.
If what is left is high for your household’s income, Trillium can cover the rest. If you are 24 or under, OHIP+ does not apply while you have a private plan.
A plan holder, such as a parent or a partner, may be able to see claims made on the plan. If that matters to you, raise it before the first fill, not after.
If you are 65 or older
The Ontario Drug Benefit covers PrEP. Depending on your income you pay a yearly deductible and then a co-payment on each fill, or, through the Seniors Co-Payment Program, no deductible and up to $2 a prescription.
The Ontario Drug Benefit guide has the amounts and the income lines for this program year.
Kind Pharmacy and PrEP
Kind Pharmacy is not yet accredited and is not open, so it cannot fill a prescription yet. Nothing on this page is an offer to.
The PrEP page says what it intends to handle once it opens, including the coverage paperwork above.
Common questions
Is PrEP covered by OHIP?
Not by OHIP itself. OHIP covers the visits and the lab tests, but not prescriptions filled outside a hospital. OHIP+, which is part of the Ontario Drug Benefit, covers PrEP for people 24 or under who have no private plan.
Can I get PrEP free without insurance?
For the first three months, often yes. PrEPStart covers people with no drug plan who have an Ontario health number or federal health coverage. After that, Trillium is the usual route, and it costs something until its deductible is paid.
Does Trillium cover PrEP?
Yes. It covers the same list of medicines as the Ontario Drug Benefit. Once a quarter’s share of your deductible is paid, each fill costs up to $2 under the Trillium Drug Program.
Do I pay for the HIV and kidney tests?
Not if you have OHIP. Medically necessary lab tests ordered by a doctor or nurse practitioner are covered, at a community lab as well as a hospital.
What does PrEP cost without any coverage?
This site cannot say. Ontario’s rules on advertising prescription prices make it impractical for a pharmacy to publish one. Ask any pharmacy for a quote: it is an ordinary question, and they will answer it.
Will my parents see it on their insurance?
They may. A drug plan can send statements to the plan holder, so a parent or a partner may see the claim. If that matters, raise it with the pharmacy before the first fill. Sometimes there is another way to pay.