Guides
The Ontario Drug Benefit, explained
Ontario’s public drug plan: who is on it, what it costs you, and what to do when a medicine is not covered. True whichever pharmacy you use.
The short version
For most people on the Ontario Drug Benefit, it started on its own. What you pay depends on how you got there: nothing, up to $2 a prescription, or more if you are a senior above an income line.
The Ontario Drug Benefit, usually shortened to ODB, is the province’s drug plan. It pays most of the cost of the medicines on its list, which is called the formulary.
It is not one program with one set of rules. There are six ways in, and each comes with its own costs. The sections below take them one at a time.
Who is on it
Everyone 65 and older
Coverage starts on the first day of the month after your 65th birthday. Ontario sends a letter about three months before. Turn 65 on 15 April, and your first day is 1 May.
24 or under, with no private plan
This is OHIP+. There is nothing to apply for: a health card number and a prescription are enough. It stops at 25, or when you join a private plan.
Ontario Works or ODSP
If you receive either, you are covered automatically. Your caseworker or a pharmacist can explain how it works.
Home and community care
If Ontario Health atHome arranges professional care services for you, you are covered automatically while you receive them.
Long-term care, or a Community Home for Opportunity
Living in either kind of home brings automatic coverage. Your care coordinator can explain the details.
The Trillium Drug Program
Trillium is for people whose drug costs are high for their household income. It is the one route here that you apply for.
Health cards
Ontario lists four of these routes as needing an Ontario health card number: long-term care, Community Homes for Opportunity, OHIP+ and Trillium.
What you pay
These are the program’s own amounts, for the year that runs from 1 August 2026 to 31 July 2027. “Up to” is the program’s wording, and it applies to each prescription filled or refilled.
24 or under, with no private plan. Nothing. Under OHIP+ the pharmacy fills the prescription at no charge.
Ontario Works, ODSP, or home and community care. The Ontario Drug Benefit charges no deductible, and up to $2 a prescription. If you are 24 or under, the $2 does not apply.
A long-term care home. No deductible and no co-payment.
A Community Home for Opportunity. The Ontario Drug Benefit charges no deductible, and up to $2 a prescription. If you are 24 or under, nothing.
Seniors with lower incomes. The Seniors Co-Payment Program removes the deductible and lowers the co-payment to up to $2. You have to apply for it; the next section explains how.
Other seniors. The Ontario Drug Benefit deductible is the first $100 of prescription costs each program year. After that, the co-payment is up to $6.11 for each prescription.
Trillium members. A deductible based on household income, then up to $2 a prescription under the Trillium Drug Program. The Trillium guide explains how the deductible is worked out.
Your first year at 65
The seniors’ $100 deductible is smaller in your first year, because it only counts the months between your start date and 31 July.
Turn 65 in April, and your coverage starts on 1 May. Ontario’s own example puts that first-year deductible at $25.
The Seniors Co-Payment Program
It is not automatic. You apply once, and you do not reapply each year if the Canada Revenue Agency can confirm your household’s income.
For the program year from 1 August 2026 to 31 July 2027, the Seniors Co-Payment Program takes people with a net income below $25,480 on their own, or below $42,290 combined with a spouse.
You can apply up to three months before your 65th birthday. Apply by 30 September to be paid back for eligible prescriptions from the program year that has just ended.
If the combined figure applies to you, your spouse’s details and signature go on the application too, whatever their age.
The application is online at forms.ontariodrugbenefit.ca. For a paper copy, the program’s toll-free line is 1-888-405-0405.
What it covers
More than 5,900 medicines are on the formulary. Almost 1,500 more can be covered through the Exceptional Access Program, when specific criteria are met.
The program also helps pay for:
- Allergy shots and epinephrine auto-injectors, at the full cost
- Diabetes test strips, up to a yearly number set by how the diabetes is treated
- Some over-the-counter medicines, when a prescriber writes a prescription for them
- Some nutrition products, when they are your only source of nutrition
- Some medicines used in palliative care
- Medicines to help quit smoking from age 18, and up to a year of counselling
Brand or generic. The program covers whichever version costs less, which usually means the generic. If you have reacted badly to at least two generics, your prescriber can fill in a Side Effect Reporting Form and write “no substitution”, and the brand is covered.
Not covered. Prescriptions filled outside Ontario, and medicines that are neither on the formulary nor approved through the Exceptional Access Program.
To check one medicine, use Ontario’s coverage search. A pharmacist can check it for you too.
Limited Use
Some listings say “Limited Use”. Those medicines are covered only in specific medical situations, and the prescriber confirms the situation by writing a three-digit Reason for Use code on the prescription.
Some of those approvals last a set time. On a refill, it is worth checking that it still applies.
When a medicine is not on the list
The Exceptional Access Program is the route for a medicine that is not on the formulary. You cannot apply yourself. Only a doctor or a nurse practitioner can send the request.
You also have to be on one of the drug programs above. Each request is judged on the medicine, what it is for, and the criteria Ontario has set for it.
Ontario says a decision takes between 3 days and 6 weeks, and it goes to the prescriber. Ask for a copy of the letter. It shows how long the approval lasts, and it helps when the approval needs renewing.
If you fill the prescription before a decision and the request is turned down, you pay for it yourself. If it is approved, the program can sometimes cover up to 30 working days before it received the request.
Getting money back
If you were covered and paid for a covered medicine anyway, you can claim it back through the Receipt Submission Form at forms.ontariodrugbenefit.ca. If you have no computer, the receipts can go by mail.
You need your health card number and the official prescription receipt, signed by a pharmacist. A till receipt or a card slip does not count.
Lost the receipt? Ask the pharmacy for a Patient Medical Expense Report, with the pharmacy’s stamp and a pharmacist’s signature.
For the Seniors Co-Payment and Trillium programs, receipts must arrive by 31 October, three months after the program year ends.
Bigger supplies
For some long-term conditions you can ask for a three-month supply. Ontario names diabetes, high cholesterol and high blood pressure as examples. It means paying the co-payment less often.
Leaving Ontario for a long stretch? Once in each program year you can get a larger supply: up to 200 days if your usual supply is under 30 days, or 100 days if it is longer.
You still pay the deductible or co-payment on it. The pharmacy needs a letter you write yourself, or a travel insurance policy, showing how long you will be away.
Kind Pharmacy and the ODB
Kind Pharmacy is not yet accredited and is not open, so it cannot bill the Ontario Drug Benefit for anything yet.
The coverage and costs page says what it intends to do about coverage once it opens.
Common questions
Do I have to apply for the Ontario Drug Benefit?
Usually not. It starts on its own at 65, for people on Ontario Works or ODSP, in long-term care or home care, and through OHIP+ for people 24 or under with no private plan. The Seniors Co-Payment Program and the Trillium Drug Program are the ones you apply for.
When does coverage start at 65?
On the first day of the month after your 65th birthday. Turn 65 on 15 April, and it starts on 1 May. Take your health card to the pharmacy.
What is the seniors’ deductible for 2026–27?
The Ontario Drug Benefit deductible is the first $100 of prescription costs in the program year, which runs from 1 August to 31 July. It is smaller in your first year, and there is none in the Seniors Co-Payment Program.
Is the $2 per prescription or per visit?
Per prescription, each time it is filled or refilled. Where a three-month supply is allowed, you pay it less often.
Does a private plan stop me getting the ODB?
If you are 24 or under, yes: OHIP+ does not apply while you are on a private plan. If you qualify through Ontario Works, ODSP, long-term care, home care or a Community Home for Opportunity, a private plan does not change that.
Does the ODB work outside Ontario?
No. Prescriptions filled outside Ontario are not covered. Before a long trip, ask about the travel supply, which you can use once a year.