Assistance with High Prescription Drug Costs
Ontario Residents can Access Trillium Drug Program to Help with Cost
Mar 17, 2009
The Ontario Drug Benefit Trillium Drug Program is available to all residents of Ontario with valid Ontario Health Insurance (OHIP) coverage, regardless of income level. Anyone with OHIP coverage who does not have private insurance coverage of their prescription drug costs is eligible to apply through the Ministry of Health and Long Term Care.
How the Program Works
Those who possess OHIP coverage must first ensure their required medications are listed in the Ontario Drug Benefit Formulary/Comparative Drug Index (ODBF/CDI). This index can be accessed through the Government of Ontario web site. Once you have verified that your prescription drugs are on this listing and have all the necessary information, a completed application can then be submitted to the Ontario Ministry of Health and Long Term Care.
In order to receive Trillium Drug Plan (TDP) benefits, you must purchase a set amount of prescription drugs, which is also called a deductible. The deductible for this program is about four per cent of the total household net income and is calculated annually. By purchasing your prescriptions at the pharmacy after you have registered for the TDP, the amount you spend is recorded. Once your prescription purchases equal the amount of your deductible for that quarter (the deductible cost is spread out over the year), your TDP coverage begins and you may pay up to $2 for every prescription until the next quarter.
Unlisted Medications
If particular medications are not listed on the index, prescribers may still apply for coverage through an Individual Review Case mechanism. This is a process where the patient's doctor must submit a form requesting coverage for a specific period of time for a particular drug that is not covered in the program. The Ministry then reviews the request and has medical experts advise them as to whether coverage should be approved. The Ministry considers requests for non-OBD medications even if the person has not yet qualified for Ontario Drug Benefit coverage. Therefore, if you require an Individual Review for your medication, you can save time by having your physician submit the form while at the same time you are applying for the program.
Limited Use and Special Drug Products
Some of the medications listed in the ODBF/CDI are only covered when used according to specific criteria and conditions. The Special Drugs Program covers the full cost of certain medications in the treatment of specific conditions for outpatients. Patients with one of the diseases or conditions covered in this plan do not have to pay deductibles or co-payments.
Trillium Drug Program Applications
Applications are available online, at most Ontario pharmacies or by calling the Ministry INFOline at (416) 314-5518 or 1-800-268-1154 (toll-free in Ontario only). More information can be accessed about the program through the link below or through the Trillium Drug Program Information line (416) 642-3038 or 1-800-575-5386 (toll-free in Ontario only).
Additional Resources:
Ontario Ministry of Health and Long-Term Care: Ontario Drug Benefit -Trillium Drug Program
For Information on Drug Coverage Throughout Canada, go to http://drugcoverage.ca
FDA: Saving Money on Prescription Drugs for U.S. Citizens
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